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Julian D. Perry - One of the best experts on this subject based on the ideXlab platform.
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dimensions and morphologic variability of the retro orbicularis oculi and Frontalis Muscle fat pad
Ophthalmic Plastic and Reconstructive Surgery, 2019Co-Authors: Alexander D Blandford, Salam P Bachour, Rachel Chen, Lucy T Xu, Catherine J Hwang, Julian D. PerryAbstract:PURPOSE: To quantify the complete dimensions of the retro-orbicularis oculi fat (ROOF) pad and to determine its relationship to other fat compartments of the forehead. METHODS: The entire forehead of 14 hemifaces of seven fresh frozen human cadavers (four female, three male) was dissected in the subcutaneous and submuscular planes. For each plane, a ruler was placed at the facial midline, and images of the dissection plane were taken at 90° and 45°. Images were analyzed for vertical height, horizontal length, the distance to midline from the point of maximal height, and area for each hemiface of the ROOF and for the entire fat compartment contiguous with the ROOF. A two-tailed t test was conducted between ROOF and ROOF plus the extended fat plane across all measurements. A Wilcoxon nonparametric signed rank test was performed to determine equivalent fat distribution of the extended fat plane over each cadaver's respective eye. RESULTS: The deep fat originating from the ROOF consistently extended laterally and superiorly in each specimen, distinctly separated via septae from the deep central, deep lateral, and the deep temporal fat compartments. The color, composition, and distribution of this contiguous deep fat did not differ phenotypically from the traditional ROOF. The extended deep fat plane possessed an average vertical height of 3.09 ± 0.68 cm, average distance to midline from point of maximal height of 3.56 ± 0.53 cm, an average horizontal length of 5.37 ± 0.82 cm, and an average area of 13.40 ± 2.69 cm. The extended deep fat demonstrated a statistically significant increase in maximal height, length, and total area compared with the ROOF. A Wilcoxon nonparametric signed rank test was nonsignificant (α = 0.01) across all measurements, demonstrating that the extended fat plane was similarly distributed over each eye. CONCLUSIONS: A layer of deep fat originating from the traditionally defined ROOF extends superiorly and laterally beneath the Frontalis Muscle, separate from the deep lateral, deep central, and deep temporal fat pads. This is the first study to clearly demonstrate a contiguous superficial musculoaponeurotic system layer of fat extending under both the orbicularis oculi and Frontalis Muscles. This plane of fat is more appropriately described as the retro-orbicularis oculi and Frontalis fat.
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Safety and Effectiveness of a Small Incision Lateral Eyebrow Ptosis Repair Technique Using a Frontalis Muscle Transposition Flap.
Ophthalmic Plastic and Reconstructive Surgery, 2016Co-Authors: Preethi S Ganapathy, Rao V Chundury, Julian D. PerryAbstract:PURPOSE To evaluate the safety and effectiveness of a Frontalis Muscle transposition flap for treatment of lateral eyebrow ptosis. METHODS The charts of all patients undergoing Frontalis Muscle transposition flap eyebrow ptosis repair from December 2013 to September 2014 were reviewed. Charts with inadequate photographs were excluded. Charts were reviewed for demographics, preoperative and postoperative photographs, surgical technique, and complications. The following parameters were assessed on preoperative and postoperative photographs: corneal diameter, central brow height, and lateral brow height. Measurements were normalized to a standard corneal diameter of 11.5 mm. Statistical analysis was performed in conjunction with the Cleveland Health Institute Biostatistics Department. RESULTS Forty-six total patients underwent Frontalis Muscle transposition flap eyebrow ptosis repair and the charts of 31 patients (53 cases) were reviewed. There were 20 female and 11 male patients. Average age was 69.1 ± 7.7 years (range: 50 - 86 years). There were 9 unilateral and 22 bilateral cases. Concomitant surgeries included upper blepharoplasty (33 cases), conjunctival-Mullerectomy blepharoptosis repair (3 cases), and intralesional tetracycline injection for festoons (3 cases). Average follow-up interval between surgery and the final postoperative photograph was 10.2 weeks (range: 6-26 weeks). Overall, lateral brow height increased postoperatively by 1.78 mm (p < 0.05). In patients that underwent Frontalis Muscle transposition flap alone, lateral brow height increased by 2.86 mm (p < 0.05). Scalp hypesthesia was documented in 10/31 patients, and resolved in 8/10 patients at last follow up. CONCLUSIONS A Frontalis Muscle transposition flap effectively addresses lateral eyebrow ptosis repair through a small, relatively concealed incision. It produces temporary scalp hypesthesia in a significant number of patients, and long-term results remain unknown.
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Frontalis Muscle asymmetry and lateral landmarks
Ophthalmic Plastic and Reconstructive Surgery, 2016Co-Authors: Bryan R. Costin, Patrick J Wyszynski, Tal J Rubinstein, Maria M Choudhary, Rao V Chundury, Jennifer M Mcbride, Mark R Levine, Julian D. PerryAbstract:PURPOSE To investigate Frontalis Muscle asymmetry and characterize its lateral interdigitation with the orbicularis oculi Muscle. METHODS After making a mid-coronal incision and bluntly dissecting to the orbital rim, the Frontalis Muscle was exposed, marked, and photographed. The right and left Muscle bellies were analyzed and compared in both pixels and cm ratios generated with NIH ImageJ software. A ratio of ≥1.5 was considered significantly asymmetric. The lateral interdigitation of the Frontalis and orbicularis oculi Muscles was measured from the supraorbital notch with a metric ruler. Data were analyzed using 2-sample t tests, paired t tests, log scales, and nonparametric tests were performed for sensitivity analyses. A p value of ≤0.05 was considered statistically significant. RESULTS Fifty-eight hemifaces of 29 Caucasian cadavers were studied for Muscle belly asymmetry. Thirty-six hemifaces of 18 Caucasian cadavers (9 males) were dissected for lateral landmarks and average age of these specimens was 73 years (range: 35-91 years). Significant asymmetry in Muscle belly area was found in 6/29 (20%) specimens, with the right Muscle belly larger in all 6 specimens. On average, the right Muscle belly area was 1.23 times that of the left (p = <0.001). The average Frontalis-orbicularis interdigitation occurred 3.4 cm lateral to the supraorbital notch. CONCLUSIONS Significant Frontalis Muscle belly asymmetry exists in 20% of Caucasians cadavers. The right Muscle belly was larger on average and in all cases of significant asymmetry. The Frontalis Muscle interdigitates with the orbicularis oculi on average 3.4 cm lateral to the supraorbital notch.
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Frontalis Muscle Asymmetry and Lateral Landmarks.
Ophthalmic Plastic and Reconstructive Surgery, 2016Co-Authors: Bryan R. Costin, Patrick J Wyszynski, Tal J Rubinstein, Maria M Choudhary, Rao V Chundury, Jennifer M Mcbride, Mark R Levine, Julian D. PerryAbstract:PURPOSE To investigate Frontalis Muscle asymmetry and characterize its lateral interdigitation with the orbicularis oculi Muscle. METHODS After making a mid-coronal incision and bluntly dissecting to the orbital rim, the Frontalis Muscle was exposed, marked, and photographed. The right and left Muscle bellies were analyzed and compared in both pixels and cm ratios generated with NIH ImageJ software. A ratio of ≥1.5 was considered significantly asymmetric. The lateral interdigitation of the Frontalis and orbicularis oculi Muscles was measured from the supraorbital notch with a metric ruler. Data were analyzed using 2-sample t tests, paired t tests, log scales, and nonparametric tests were performed for sensitivity analyses. A p value of ≤0.05 was considered statistically significant. RESULTS Fifty-eight hemifaces of 29 Caucasian cadavers were studied for Muscle belly asymmetry. Thirty-six hemifaces of 18 Caucasian cadavers (9 males) were dissected for lateral landmarks and average age of these specimens was 73 years (range: 35-91 years). Significant asymmetry in Muscle belly area was found in 6/29 (20%) specimens, with the right Muscle belly larger in all 6 specimens. On average, the right Muscle belly area was 1.23 times that of the left (p =
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Small-incision Frontalis Muscle transposition flap for lateral eyebrow ptosis repair.
Ophthalmic Plastic and Reconstructive Surgery, 2015Co-Authors: Bryan R. Costin, Julian D. PerryAbstract:PURPOSE To describe a novel technique to correct lateral eyebrow ptosis using a Frontalis Muscle transposition flap. METHODS The charts of all patients undergoing eyebrow ptosis repair using a Frontalis Muscle transposition flap from December 2013 through April 2014 were reviewed to describe the surgical technique. RESULTS Sixteen patients underwent eyebrow ptosis repair using a Frontalis Muscle pedicle flap during the study period. Briefly, after local infiltration, a lateral forehead rhytid was marked and incised for approximately 1.5 cm. Blunt dissection exposed the Frontalis-orbicularis angle, the Frontalis-orbicularis insertion, and the lateral extent of the Frontalis Muscle. A pedicle flap of lateral Frontalis Muscle was created, trimmed, and transposed laterally in graded fashion to achieve the optimal eyebrow height and contour. The incision was closed with 5-0 polypropylene suture. All patients reported improvement in eyebrow position. CONCLUSIONS This novel technique provides Frontalis Muscle elevatory force to the lateral eyebrow through a small incision to improve eyebrow ptosis. Further study, including objective measures of long-term results, is required.
Bing Li - One of the best experts on this subject based on the ideXlab platform.
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Frontalis Muscle transfer technique for correction of severe congenital blepharoptosis in chinese patients an analysis of surgical outcomes related to Frontalis Muscle function
Journal of Plastic Reconstructive and Aesthetic Surgery, 2015Co-Authors: Ying Shao, Xiaojie Yu, Bing Li, Duo ZhangAbstract:Summary Aim The aim of this study is to evaluate the surgical outcomes related to Frontalis Muscle function using the Frontalis Muscle transfer technique in Chinese patients with severe congenital blepharoptosis and poor levator function. Materials and method Between December 2003 and December 2011, using the Frontalis Muscle transfer technique, 37 patients of Chinese origin underwent surgery on 53 eyelids. The Frontalis Muscle function was assessed and categorized as poor (excursion ≤ 7 mm) and good (excursion > 7 mm) before the surgery. The results, including complications of the treatment procedure, were followed up and evaluated. Using the Cochran–Mantel–Haenszel statistic, the preoperative ptosis severity was compared with the degree of ptosis correction, and the preoperative Frontalis Muscle function was compared with the degree of ptosis correction using Fisher's exact test for paired data. A two-sided value of p Results Of the total eyelids considered, sufficient postoperative correction of ptosis was achieved in 43 eyelids (81.1%), while the correction was insufficient in 10 eyelids (18.9%). Fifteen (28.3%) eyelids were either overcorrected ( n = 5) or undercorrected ( n = 10). The rate of lagophthalmos was 3.8%. Eyelids with preoperative Frontalis Muscle function >7 mm had a higher rate of sufficient correction in comparison to those with preoperative Frontalis Muscle function ≤7 mm (91.2% vs. 63.2%; p Conclusion The Frontalis Muscle is the main motor Muscle used in the correction of severe blepharoptosis via the Frontalis Muscle transfer technique. Although the technique is considered to be an effective surgical method for the correction of severe blepharoptosis, the outcome of the correction procedure depends on the preoperative Frontalis Muscle function of the patient.
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Frontalis Muscle flap suspension for the correction of congenital blepharoptosis in early age children
PLOS ONE, 2013Co-Authors: Gehong Li, Lin Fang, Bing LiAbstract:Background We aimed to report our successful use of Frontalis Muscle flap suspension for the correction of congenital blepharoptosis in early age children.
Duo Zhang - One of the best experts on this subject based on the ideXlab platform.
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An Unexpected Conjunctival Prolapse Following Frontalis Muscle Flap Transfer for Severe Ptosis.
Journal of Craniofacial Surgery, 2019Co-Authors: Jiaqi Wang, Hai-peng Liu, Zhong-yuan Tang, Xia Yin, Duo ZhangAbstract:Conjunctival prolapse may occur following ocular, eyelid, and orbital surgeries. Conjunctival prolapse usually results as a complication of maximal levator resection or cosmetic lower eyelid blepharoplasty. Here, we describe conjunctival prolapse as an unexpected complication of Frontalis Muscle flap transfer for severe ptosis. On postoperative day 5, the patient experienced upper eyelid swelling after closing his eyes suddenly and standing up abruptly. The conjunctiva was reddish and ballooned up, and they protruded over the eyelids. Conjunctival prolapse persisted until postoperative day 8. The patient and surgeon were concerned that this complication would affect ptosis correction and surgical outcome. U-shaped fixations were placed to suture and force the prolapsed conjunctiva back to their normal anatomical positions. At postoperative 6 months, the patient had not experienced additional issues, and he was satisfied with the appearance of his eyes. This report describes a rare clinical case of conjunctival prolapse and provides a reference for surgeons treating similar complications.
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Frontalis Muscle transfer technique for correction of severe congenital blepharoptosis in chinese patients an analysis of surgical outcomes related to Frontalis Muscle function
Journal of Plastic Reconstructive and Aesthetic Surgery, 2015Co-Authors: Ying Shao, Xiaojie Yu, Bing Li, Duo ZhangAbstract:Summary Aim The aim of this study is to evaluate the surgical outcomes related to Frontalis Muscle function using the Frontalis Muscle transfer technique in Chinese patients with severe congenital blepharoptosis and poor levator function. Materials and method Between December 2003 and December 2011, using the Frontalis Muscle transfer technique, 37 patients of Chinese origin underwent surgery on 53 eyelids. The Frontalis Muscle function was assessed and categorized as poor (excursion ≤ 7 mm) and good (excursion > 7 mm) before the surgery. The results, including complications of the treatment procedure, were followed up and evaluated. Using the Cochran–Mantel–Haenszel statistic, the preoperative ptosis severity was compared with the degree of ptosis correction, and the preoperative Frontalis Muscle function was compared with the degree of ptosis correction using Fisher's exact test for paired data. A two-sided value of p Results Of the total eyelids considered, sufficient postoperative correction of ptosis was achieved in 43 eyelids (81.1%), while the correction was insufficient in 10 eyelids (18.9%). Fifteen (28.3%) eyelids were either overcorrected ( n = 5) or undercorrected ( n = 10). The rate of lagophthalmos was 3.8%. Eyelids with preoperative Frontalis Muscle function >7 mm had a higher rate of sufficient correction in comparison to those with preoperative Frontalis Muscle function ≤7 mm (91.2% vs. 63.2%; p Conclusion The Frontalis Muscle is the main motor Muscle used in the correction of severe blepharoptosis via the Frontalis Muscle transfer technique. Although the technique is considered to be an effective surgical method for the correction of severe blepharoptosis, the outcome of the correction procedure depends on the preoperative Frontalis Muscle function of the patient.
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One-stage correction of blepharophimosis-ptosis-epicanthus inversus syndrome using a Frontalis Muscle transfer technique.
Journal of Plastic Surgery and Hand Surgery, 2013Co-Authors: Hai-peng Liu, Ying Shao, Ziran Zhao, Duo ZhangAbstract:Blepharophimosis-ptosis-epicanthus inversus (BPES) is a rare genetic disease involving a complex eyelid malformation. The surgical treatment approach for BPES is highly complex and a subject of controversy. This study reports the results of a one-stage Frontalis Muscle transfer technique to correct BPES. This retrospective, interventional study included 21 patients with BPES who had been followed-up for a minimum of 1 year. The one-stage intervention was a combination of three surgical techniques: Mustarde medial canthoplasty, Fox lateral canthoplasty, and the Frontalis Muscle transfer technique. Preoperative and postoperative measurements of the horizontal lid fissure length (HLFL), vertical lid fissure width (VLFW), inner intercanthal distance (IICD), and the IICD/HLFL ratio were analyzed by Wilcoxon's signed rank test. The mean preoperative measurements were 4.73 ± 0.32 mm for VLFW, 19.98 ± 3.74 mm for HLFL, 40.85 ± 4.46 mm for IICD, and 2.11 ± 0.45 mm for the IICD/HLFL ratio. The mean postoperative measurements were 7.86 ± 0.41 mm for VLFW, 24.47 ± 3.35 mm for HLFL, 32.52 ± 4.16 mm for IICD, and 1.35 ± 0.22 mm for the IICD/HLFL ratio (p < 0.0001 for all preoperative vs postoperative values). Postoperative complications included eyelid fold deformities, lagophthalmos, and conspicuous scars. Most of these complications gradually resolved. One-stage correction of BPES is safe and efficient with the surgical techniques described.
Jiaqi Wang - One of the best experts on this subject based on the ideXlab platform.
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An Unexpected Conjunctival Prolapse Following Frontalis Muscle Flap Transfer for Severe Ptosis.
Journal of Craniofacial Surgery, 2019Co-Authors: Jiaqi Wang, Hai-peng Liu, Zhong-yuan Tang, Xia Yin, Duo ZhangAbstract:Conjunctival prolapse may occur following ocular, eyelid, and orbital surgeries. Conjunctival prolapse usually results as a complication of maximal levator resection or cosmetic lower eyelid blepharoplasty. Here, we describe conjunctival prolapse as an unexpected complication of Frontalis Muscle flap transfer for severe ptosis. On postoperative day 5, the patient experienced upper eyelid swelling after closing his eyes suddenly and standing up abruptly. The conjunctiva was reddish and ballooned up, and they protruded over the eyelids. Conjunctival prolapse persisted until postoperative day 8. The patient and surgeon were concerned that this complication would affect ptosis correction and surgical outcome. U-shaped fixations were placed to suture and force the prolapsed conjunctiva back to their normal anatomical positions. At postoperative 6 months, the patient had not experienced additional issues, and he was satisfied with the appearance of his eyes. This report describes a rare clinical case of conjunctival prolapse and provides a reference for surgeons treating similar complications.
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evaluation of moderate and severe blepharoptosis correction using the interdigitated part of the Frontalis Muscle and orbicularis oculi Muscle suspension technique a cohort study of 235 cases
Journal of Plastic Reconstructive and Aesthetic Surgery, 2017Co-Authors: Tailing Wang, Xiuqi Li, Xiao Wang, Qianwen Wang, Wuyan Li, Lu Zhou, Weiming Song, Jiaqi WangAbstract:Summary Background Blepharoptosis is defined as an abnormally low-lying upper eyelid margin in the primary gaze, causing vertical narrowing of the palpebral fissure. It is difficult to achieve consistently satisfactory results in moderate or severe cases despite many surgical methods being available to correct them. Methods Between January 2001 and December 2014, a retrospective cohort study was conducted using medical records and perioperative photographs of 235 patients. All the patients, having presented with moderate or severe bilateral or unilateral blepharoptosis, underwent blepharoptosis correction with the interdigitated orbicularis oculi–Frontalis Muscle flap suspension technique and contemporaneous double-eyelid surgery. The results, including complications, were followed up and evaluated. Results The mean age of the patients was 17.4 years (range 3–50 years). The follow-up period ranged from 6 months to 8 years, with a mean follow-up of 13 months. Long-term postoperative complications included undercorrection (3.0%), overcorrection (0.7%) and eyelid fold deformity (4.0%). No ectropion, entropion, fornix conjunctival prolapse or exposure keratitis was noted. Conclusions Blepharoptosis correction with interdigitated orbicularis oculi–Frontalis Muscle flap suspension is an effective technique for the management of moderate or severe blepharoptosis. The results demonstrated very low complication rates and substantial cosmetic and functional improvement using simple manipulation.
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Long-term Histopathologic Study of the Frontalis Muscle Flap After Frontalis Suspension for Severe Ptosis Repair
Ophthalmic Plastic and Reconstructive Surgery, 2013Co-Authors: Chong Zou, Jiaqi Wang, Xin Guo, Tailing WangAbstract:Purpose: To investigate the long-term histopathologic changes of the Frontalis Muscle flap after Frontalis Muscle flap suspension for severe ptosis repair. Methods: Eight 3-month miniature pigs were selected as the experimental animals, and self-comparison was used. The experimental side of the upper eyelid was constructed to have severe ptosis by resection of the levator aponeurosis, while the other side served as the control. Samples of the upper eyelid composite at 6 months and 12 months after ptosis repair were obtained and studied through light microscopy and transmission electron microscopy. Results: The histopathologic study revealed that the Frontalis Muscle flap kept viable with normal muscular structure and direction 6 months and 12 months after the Frontalis suspension procedure. Conclusions: The Frontalis Muscle flap appears to be a suitable material for Frontalis suspension technique because of its feasibility and histopathologic stability.
Zhu Jiali - One of the best experts on this subject based on the ideXlab platform.
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two different correction surgery for congenital blepharoptosis
Journal of Hainan Medical University, 2012Co-Authors: Zhu JialiAbstract:Objective: To compare two correction surgery for congenital blepharoptosis.Methods:A total of 126 eyes of 98 patients with congenital blepharoptosis admitted from August 2001 to August 2011 were selected.They had levator palpebrae superioris Muscle shortening and Frontalis Muscle suspension surgery and were followed up for 4 weeks.Results:Levator palpebrae superioris Muscle shortening for mild congenital blepharoptosis patients was significantly more effective than it for moderate and severe congenital blepharoptosis patients(P 0.05);while Frontalis Muscle suspension surgery was more effective for moderate and severe congenital blepharoptosis patients(P 0.05).Conclusions:Levator palpebrae superioris Muscle shortening can keep function of palpebra superior,and achieve cosmetic purpose,which is applicable to mild congenital blepharoptosis;Frontalis Muscle suspension surgery can shift palpebra superior,and can apply to moderate and severe congenital blepharoptosis.
